Uterine transplant: This prospect for pregnancy is not worth the risks

Historically, society has impressed upon girls the notion that to become “real mothers” they must carry a pregnancy themselves. The desire for pregnancy is so strong that some women are willing to risk their health in order to have a baby.

Uterine transplantation – a major surgical procedure currently in clinical trials – is marketed as a ray of hope for women with conditions that prohibit pregnancy, such as an abnormally shaped uterus or vagina. However, the procedure carries considerable risks that outweigh its potential benefits.

The high-risk pregnancy doctors in our practice do not recommend uterine transplantation. We strongly believe that women can become mothers in a variety of ways, and uterine transplantation is not worth the risks. To help women understand those risks and other important considerations requires a deeper dive into the procedure. 

History of uterine transplant

The first reported uterine transplant was performed in Saudi Arabia in 2000. The recipient was a 26-year-old who had suffered a postpartum hemorrhage after a Cesarean section, resulting in hysterectomy. Her donor was a woman in her 40s who was having a hysterectomy and agreed to donate her uterus. The procedure was promising – the patient had two spontaneous menstrual cycles before blood flow failed to the uterus and she had to have it removed after three months.

In 2014, a medical group in Sweden reported the first live birth after a uterine transplant. The recipient was 35, and she had a müllerian anomaly (a gynecologic birth defect). Interestingly, her donor was 61. The pregnancy resulted in a live birth, though the baby was premature by two months.

In the U.S., experiences have been similar. The first U.S. uterine transplant was performed in 2016 at the Cleveland Clinic. The patient experienced a potentially life-threatening complication and had to have the uterus removed less than two weeks after her surgery. Baylor reported its first live birth after transplant in 2017. Today, uterine transplantation is not available outside research protocols.

My concerns about uterine transplantation

Organ transplantations are major procedures that require extensive physical and mental preparation. While some of the risks associated with uterine transplantation are similar to those associated with transplantation of other organs, the procedure opens the door to unique and potentially traumatic physical and emotional experiences.

Physical risks

Any type of organ transplant requires that patients take potent immunosuppressant drugs to prevent the body from attacking the new organ as a foreign invader (much like the body attacks viruses). 

The potential side effects of anti-rejection drugs can be worth the risk for life-saving procedures such as heart or lung transplants. However, for an elective procedure meant to result in pregnancy, the risks outweigh the potential benefits. And although doctors work to optimize these drug treatments prior to pregnancy, the drugs can cause low birth weight, premature birth, and increased risk of birth defects.

All transplant procedures also bring immediate risks, such as:

• Blood loss requiring transfusion
  
• Infection
  
• Organ rejection
  
• Potential for adverse reaction to anti-rejection medications

Also, uterine transplant procedures are not meant to be permanent. Even if the transplant is successful, taking anti-rejection drugs over the long term for a non-life-threatening condition is not advised. So, patients must have a hysterectomy at some point – usually following one or two pregnancies.

Emotional risks

Uterine transplantation sets up women for potentially significant emotional and mental health concerns. Patients who want the procedure typically have gone through multiple rounds of infertility treatment and likely have coped with pregnancy loss. Unfortunately, these traumatic experiences can occur even with a successful transplant, and doctors must help patients prepare for that possibility.

Women also must be prepared for financial implications. Patients and their partners are required to undergo fertility treatment before a uterine transplant to determine whether pregnancy could be possible in the event of a successful procedure. Women will be asked to freeze their eggs as a failsafe, which can be expensive depending on insurance coverage. 

As mentioned, this procedure is currently available only as a clinical trial. It is likely that uterine transplant will be incredibly expensive outside of study protocols. We have no way to estimate the potential future cost or determine whether insurance companies will cover the procedure and required doctor visits, anti-rejection drugs, and cervical biopsies to look for signs of rejection.

We do not recommend uterine transplant to our patients because of the risks to women and families. While the idea of carrying one’s own baby has been romanticized by society as the only “real” route to motherhood, that logic is harmful to women. Every week in our clinic we see patients who became mothers in a variety of ways, from in vitro fertilization to surrogacy, and from adoption to step-parenting. And if you ask these moms, they’ll tell you their love for their children is real and endless, no matter how they achieved motherhood.

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